Patterns and predictors of symptoms, falls, and functioning across treatment and recovery in patients treated with neurotoxic chemotherapy for cancer

接受神经毒性癌症化疗的患者在整个治疗和康复过程中的症状、跌倒和功能的模式和预测因素

• 批准号: 10440516
• 负责人: KERRI M WINTERS-STONE
• 金额: $ 62.19万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10440516
• 关键词: Address; Adverse effects; Aftercare; Age; Attention; Behavioral; Body mass index; Cancer Patient; Cancer Survivor; Caring; Characteristics; Chemotherapy-Oncologic Procedure; Chemotherapy-induced peripheral neuropathy; Clinical; Clinical Pathways; Clinical Practice Guideline; Clinical assessments; Data; Development; Dose; Early Diagnosis; Early Intervention; Equilibrium; Etiology; Fall prevention; Gait; Gait abnormality; Goals; Growth; Guidelines; Health Care Costs; Impairment; Intervention; Knowledge; Lead; Life; Link; Long-Term Survivors; Longitudinal Studies; Malignant Neoplasms; Measures; Medication Management; Modeling; Monitor; Neuropathy; Obesity; Oncology; Pain management; Patient Self-Report; Patients; Pattern; Peripheral Nervous System Diseases; Persons; Phase; Physical Function; Physical activity; Prevention strategy; Provider; Quality of life; Recording of previous events; Recovery; Rehabilitation therapy; Reporting; Resources; Risk; Risk Factors; Survivors; Symptoms; Technology; Testing; Treatment Side Effects; Treatment-Related Cancer; Woman; aggressive therapy; cancer care; cancer therapy; chemotherapy; clinical practice; comorbidity; disability; disability risk; fall risk; falls; follow-up; functional decline; functional disability; high risk; improved; innovation; men; neurotoxic; novel; patient safety; productivity loss; rehabilitation strategy; sex; shared decision making; sociodemographics; survivorship; treatment planning

Recent reports suggest that falls increase by 25%-50% in cancer patients and are linked to treatment-related side effects, such as chemotherapy-induced peripheral neuropathy (CIPN), that alter mobility (gait and balance). Falls and functional impairments in cancer patients remain largely unrecognized and under-treated, in part because it is not yet known what level of symptoms impact mobility, the specific mobility deficits that increase fall and disability risk, or which patients are most at risk. Our long-term objective is to prevent falls and disability associated with cancer treatment by informing clinicians about which and when patients show increased risk for falls and functional decline and informing rehabilitation providers about which mobility deficits to target. A critical first step toward this objective is to characterize the natural trajectories of symptoms, functioning, and falls across the in-treatment and recovery phases of cancer care. To achieve this goal, we will use detailed symptom tracking, simple clinical tests, passive continuous monitoring of daily mobility and physical activity, and self-report falls and disability collected before, during, and one year after treatment in 200 patients prescribed neurotoxic chemotherapy for cancer. The Specific Aims of this study are: 1) to characterize trajectories of neuropathy symptoms and functioning (objective mobility, physical activity, self-report functioning and disability) across treatment and one year of recovery among persons receiving neurotoxic chemotherapy for cancer and 2) Determine the simplest predictors of symptom and functioning trajectories to identify patients in whom different treatment options should be considered and/or who would benefit from early and targeted rehabilitation interventions. This study is innovative because it will be the first study to 1) reveal how cancer treatment could lead to increased risk of falls and disability in survivorship, 2) measure changes in symptoms, mobility and falls across a course of chemotherapy and into recovery, 3) employ continuous passive monitoring technologies as sensitive and specific measures of mobility and activity changes during daily life; and, 4) apply a novel analytic approach - growth mixture modeling (GMM) - to identify the distinct trajectories of changes in symptoms, functioning and falls associated with neurotoxic chemotherapy. Collectively the knowledge gained from this study can be used to identify which patients might benefit from early intervention via alterations in treatment plans and/or referral to rehabilitation. Findings from this study could provide new information for oncology teams to improve patient safety and enhance survivorship care plans for those receiving neurotoxic chemotherapies. Currently, clinical practice guidelines focus on pharmacologic management of pain associated with CIPN, which remains suboptimal, with little attention to prevention of falls and functional decline. This study could have a significant impact by defining the natural trajectories of functional declines related to CIPN so that early detection efforts can be integrated into the clinical pathway of patients receiving neurotoxic treatment and targeted care provided for at-risk patients.

最近的报告表明，癌症患者的跌倒增加了25%-50%，这与治疗有关